The impact of pulmonary hypertension on outcomes of transcatheter mitral valve replacement in mitral annular calcification

Hector R. Cajigas, Tatiana Kaptzan, Bradley Lewis, Abdallah El-Sabbagh, Mohammed Al-Hijji, Mackram Eleid, Mohamad Alkhouli, Dee Dee Wang, Marvin Eng, Susheel Kodali, Isaac George, Tarun Chakravarty, Ashish Pershad, Daniel O'Hair, Noah Jones, Raj Makkar, Mark Reisman, Martin Leon, William O'Neill, Charanjit RihalMayra Guerrero

Research output: Contribution to journalArticlepeer-review


Objectives: To assess the impact of pulmonary hypertension (PH) on outcomes of patients with severe mitral annular calcification (MAC) undergoing transcatheter mitral valve replacement (TMVR). Background: PH is associated with poor outcomes after mitral valve surgery. Whether the presence of PH in patients with MAC undergoing (TMVR) is associated with poor outcomes, is unknown. Methods: Retrospective evaluation of 116 patients from 51 centers in 11 countries who underwent TMVR with valve in mitral annular calcification (ViMAC) using balloon-expandable aortic transcatheter valves (THVs) from September 2012 to March 2017. Pulmonary artery systolic blood pressure (PASP) by echocardiogram was available in 90 patients. The subjects were stratified based on PASP: No PH = PASP ≤35 mmHg (n = 11); mild to moderate PH = PASP 36–49 mmHg (n = 21) and severe PH = PASP ≥50 mmHg (n = 58). Clinical, procedural, and echocardiographic outcomes were assessed. Results: Mean age was 72.7 (±12.8) years, 59 (65.6%) were female, Society of Thoracic Surgeons score was 15.8 + 11.8% and 90.0% where in New York Heart Association (NYHA) class III–IV. There was no significant difference in all-cause mortality at 30 days (no PH = 27.3%, mild–moderate PH = 19.0%, severe PH = 31.6%; p = 0.55) or at 1 year (no PH = 54.5%, mild–moderate PH = 38.1%, severe PH = 56.1%; p = 0.36). No difference in adverse events, NYHA class or amount of residual mitral regurgitation at 1 year were observed between the groups. Conclusion: This study suggests that the presence of PH in patients with predominantly mitral stenosis with MAC undergoing TMVR does not impact mortality or adverse events. Further studies are needed to fully understand the effect of PH in this group of patients.

Original languageEnglish (US)
Pages (from-to)1647-1658
Number of pages12
JournalCatheterization and Cardiovascular Interventions
Issue number5
StatePublished - Apr 1 2022


  • mitral annular calcification
  • pulmonary hypertension
  • transcatheter mitral valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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